Assuntos
Diabetes Mellitus Tipo 2/complicações , Necrose Papilar Renal/cirurgia , Ureteroscopia/métodos , Nefropatias Diabéticas/diagnóstico por imagem , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/cirurgia , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Hidronefrose/cirurgia , Necrose Papilar Renal/diagnóstico por imagem , Necrose Papilar Renal/etiologia , Necrose Papilar Renal/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UrografiaAssuntos
Hematúria/diagnóstico por imagem , Necrose Papilar Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Infecções Urinárias/diagnóstico por imagem , Urografia/métodos , Diagnóstico Diferencial , Hematúria/complicações , Humanos , Necrose Papilar Renal/complicações , Infecções Urinárias/complicaçõesAssuntos
Anemia Falciforme/complicações , Isquemia/etiologia , Medula Renal/irrigação sanguínea , Necrose Papilar Renal/etiologia , Talassemia beta/complicações , Acetaminofen/efeitos adversos , Adulto , Analgésicos não Narcóticos/efeitos adversos , Feminino , Hematúria/etiologia , Humanos , Isquemia/diagnóstico por imagem , Medula Renal/diagnóstico por imagem , Necrose Papilar Renal/diagnóstico por imagem , Urografia/métodosRESUMO
Sickle cell disease (SCD) is a major health problem in many countries. Sickle cell nephropathy (SCN) is now a well-characterized entity with specific manifestations, risk factors and prognosis. The presence of sickled erythrocytes in the renal medullary vessels is the hallmark of the disease with a variety of renal complications. Renal manifestations of SCD include renal ischemia, microinfarcts, renal papillary necrosis and renal tubular abnormalities with variable clinical presentations. Proximal tubule dysfunction generally impairs urinary concentration, while more distal tubule dysfunction may impair potassium excretion, leading to hyperkalemia. Glomerular disease with proteinuria may develop due to ischemia and results in a compensatory increase in the renal blood flow and glomerular filtration rate; such hyperfiltration, combined with glomerular hypertrophy, probably contributes to glomerulosclerosis. Acute and chronic kidney disease are the expected outcomes of the disease. Both dialysis and kidney transplantation are effective renal replacement therapies for end-stage renal disease due to SCN, with a higher advantage for transplantation. Whether bone marrow transplantation in the early stage of the disease can halt the progression of SCN is unknown and awaits clinical studies.
Assuntos
Anemia Falciforme/complicações , Nefropatias/etiologia , Necrose Papilar Renal/etiologia , Anemia Falciforme/fisiopatologia , Taxa de Filtração Glomerular , Hematúria/etiologia , Hematúria/fisiopatologia , Humanos , Nefropatias/fisiopatologia , Nefropatias/terapia , Necrose Papilar Renal/diagnóstico por imagem , Necrose Papilar Renal/fisiopatologia , Transplante de Rim , Túbulos Renais/fisiopatologia , Radiografia , Diálise Renal , UltrassonografiaAssuntos
Analgésicos/efeitos adversos , Aspirina/efeitos adversos , Cefaleia/tratamento farmacológico , Processamento de Imagem Assistida por Computador/métodos , Necrose Papilar Renal/induzido quimicamente , Necrose Papilar Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Analgésicos/administração & dosagem , Aspirina/administração & dosagem , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Hematúria/etiologia , Humanos , Aumento da Imagem/métodos , Assistência de Longa Duração , Pessoa de Meia-IdadeRESUMO
A 9-year-old girl presented with apparent meningococcal septicemia and developed acute renal failure after 48 hours of treatment with antibiotics and analgesics. Early ultrasound scanning demonstrated mild bilateral hydronephrosis and hydroureter. Intravenous urography showed slow contrast uptake with delay nephrogram and no contrast entering the bladder. Repeat ultrasonography revealed bilateral papillary irregularity and echogenic debris in the distal ureters. Bilateral double-J stents were inserted cystoscopically, resulting in prompt polyuria and a return of normal renal function. Although rare, recognition of sloughed papilla in papillary necrosis causing ureteral obstruction can lead to early management with no long-term sequelae.
Assuntos
Necrose Papilar Renal/complicações , Necrose Papilar Renal/diagnóstico , Obstrução Ureteral/etiologia , Doença Aguda , Injúria Renal Aguda/etiologia , Criança , Cistoscopia , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Rim/diagnóstico por imagem , Necrose Papilar Renal/diagnóstico por imagem , Necrose Papilar Renal/etiologia , Sepse/complicações , Stents , Ultrassonografia , Obstrução Ureteral/terapia , Cateterismo UrinárioRESUMO
Renal papillary necrosis is not a pathologic entity but rather a descriptive term for a condition--necrosis of the renal papillae--that has various possible causes. The renal medulla and papillae are vulnerable to ischemic necrosis because of the peculiar arrangement of their blood supply and the hypertonic environment. The etiology of renal papillary necrosis includes diabetes, analgesic abuse or overuse, sickle cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive uropathy. Renal papillary necrosis has been diagnosed with the use of intravenous urography and ultrasonography, but contrast material-enhanced computed tomography (CT) may better depict a full range of typical features, including contrast material-filled clefts in the renal medulla, nonenhanced lesions surrounded by rings of excreted contrast material, and hyperattenuated medullary calcifications. In the presence of papillary sloughing, CT may depict hydronephrosis and filling defects in the renal pelvis or ureter, which also may contain calcifications. During healing, the epithelialized papillary tip appears blunted. Shrinkage of the kidney, a common sequela, also may be detected at CT. Multi-detector row CT depicts these and other features more clearly and directly than single-detector row CT, given the advantages of thinner sections and multiplanar reformation, and it may help identify the condition at an earlier stage, when effective treatment can reverse the ischemic process. Familiarity with the CT features of the condition therefore is useful for its successful diagnosis and management.
Assuntos
Meios de Contraste/administração & dosagem , Necrose Papilar Renal/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Humanos , Injeções Intravenosas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Estatística como Assunto , Tomografia Computadorizada por Raios X/instrumentaçãoAssuntos
Fístula Gástrica/diagnóstico por imagem , Cálculos Renais/complicações , Nefropatias/diagnóstico por imagem , Tomografia Computadorizada Espiral , Fístula Urinária/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/patologia , Abscesso/cirurgia , Adulto , Feminino , Fístula Gástrica/patologia , Fístula Gástrica/cirurgia , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Nefropatias/patologia , Nefropatias/cirurgia , Necrose Papilar Renal/diagnóstico por imagem , Necrose Papilar Renal/patologia , Necrose Papilar Renal/cirurgia , Pelve Renal/diagnóstico por imagem , Pelve Renal/patologia , Pelve Renal/cirurgia , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Pielonefrite Xantogranulomatosa/patologia , Ruptura Espontânea , Fístula Urinária/patologia , Fístula Urinária/cirurgiaRESUMO
Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.
Assuntos
Enfisema/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Necrose Papilar Renal/tratamento farmacológico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Terapia Combinada , Desbridamento , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Suscetibilidade a Doenças , Drenagem , Quimioterapia Combinada/uso terapêutico , Enfisema/diagnóstico por imagem , Enfisema/cirurgia , Infecções por Escherichia coli/diagnóstico por imagem , Infecções por Escherichia coli/cirurgia , Feminino , Humanos , Insulina/uso terapêutico , Necrose Papilar Renal/diagnóstico por imagem , Necrose Papilar Renal/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Emphysematous pyelonephritis (EPN) is an acute life-threatening bacterial infection. EPN leads to rapid necrotizing destruction of the renal parenchyma and peri-renal tissue, requiring early and aggressive care to reduce morbidity and mortality. Previous studies have described the use of computed tomography scan and radiology-performed ultrasound to make the diagnosis of EPN We report a case of EPN diagnosed by bedside Emergency Department (ED) ultrasound performed by emergency physicians, allowing a more rapid diagnosis and subsequent treatment.
Assuntos
Serviço Hospitalar de Emergência , Necrose Papilar Renal/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Necrose Papilar Renal/fisiopatologia , Necrose Papilar Renal/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
AIM: To evaluate the clinical usefulness of early cortical phase images in the diagnosis of acute pyelonephritis and to compare the measurements of differential renal function obtained by both 99mTc ethylene dicysteine (99mTc-EC) and 99mTc dimercaptosuccinic acid (99mTc-DMSA). METHODS: Forty-three children who had undergone both 99mTc-EC and 99mTc-DMSA studies within 5 days of acute infection were studied. Cortical images of 99mTc-EC were obtained by the sum of the renogram frames achieved between the first 60-120 s of the renogram study. DMSA and EC images were visually interpreted using four points of semiquantitative ratings: 0, normal; 1, mild hypoactivity; 2, moderate hypoactivity with partial loss of margins; 3, marked hypoactivity with loss of cortical margins. Values for the differential renal function were obtained for both studies. RESULTS: DMSA detected a total of 109 lesions in 36 patients and EC detected 90 lesions with a sensitivity of 82.5%. 99mTc-EC successfully detected moderate-to-severe cortical lesions but was less effective with mild lesions (sensitivity 60%). Bland-Altman analysis demonstrated good agreement among the results for differential renal function (95% CI -0.26 to 0.96). CONCLUSION: 99mTc-EC early phase images detected most of the cortical lesions. Its sensitivity depends on the severity of the lesions. EC provided reliable information in the estimation of differential renal function.
Assuntos
Cisteína/análogos & derivados , Córtex Renal/diagnóstico por imagem , Necrose Papilar Renal/classificação , Necrose Papilar Renal/diagnóstico por imagem , Compostos de Organotecnécio , Renografia por Radioisótopo/métodos , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Testes de Função Renal/métodos , Necrose Papilar Renal/diagnóstico , Masculino , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
A 57-year-old woman, known to have diabetes mellitus, presented with a one-week history of fever, dysuria, and left flank pain. Computed tomography showed extensive left renal parenchymal destruction and a large gas collection. Urine culture revealed growth of Escherichia coli. The diagnosis of emphysematous pyelonephritis was confirmed at left nephrectomy. The clinical manifestations of emphysematous pyelonephritis, types of gas-forming renal infection, and their radiological findings are discussed.
Assuntos
Enfisema/diagnóstico por imagem , Necrose Papilar Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Complicações do Diabetes , Enfisema/microbiologia , Enfisema/terapia , Infecções por Escherichia coli , Feminino , Humanos , Necrose Papilar Renal/microbiologia , Necrose Papilar Renal/terapia , Pessoa de Meia-Idade , Nefrectomia , Resultado do TratamentoRESUMO
PURPOSE: The feasibility of identifying early manifestations of renal papillary necrosis (RPN) and medullary necrosis (RMN) on multiphasic helical CT, leading to prompt treatment for the causative conditions, and its impact on reducing the incidence of late-stage RML and RPN, was investigated. PATIENTS AND METHODS: Sixty-eight patients (35 male, 33 female) aged 19 to 88 years were examined by multiphasic helical CT for complaints of microscopic hematuria (N=49), macroscopic hematuria (N=2), bacteriuria (N=45), pyuria (N=10), fever (N=15), and flank pain (N=27). Preenhancement, arterial corticomedullary, parenchymal, and excretory phase scans generated 1.25 to 7-mm-thick slices. Follow-up CTs were performed at 1 month (N=62) and 3 months (N=58). RESULTS: While the attenuation coefficients of areas suspect for RMN and RPN were similar on preenhancement CT, they differed substantially on the arterial corticomedullary phase (lesions 55 HU mean; normal medulla 120 HU mean) and parenchymal phase (lesions 58 HU mean, normal medulla 210 HU mean). Investigation for predisposing conditions identified diabetes in 18 patients, upper urinary-tract infections in 48, sickle-cell disease or trait in 17, urinary obstruction in 7, and cirrhosis of the liver in 1. On follow-up examinations, enhancement had normalized in 26 compromised areas of 14 patients at 1 month, and 47 areas (23 patients) at 3 months, remained stationary in 28 patients at 1 month and 9 at 3 months, and progressed in 20 at 1 and 26 at 3 months (P<0.001; Fisher's exact test). Patients (N=35) treated for underlying conditions causing ischemia showed reperfusion in 12 cases at 1 month and 20 at 3 months, while of the untreated patients (N=10), none showed reperfusion, and all lesions increased in size. CONCLUSIONS: Multiphasic helical CT is recommended for identification of RMN and RPN at a stage when effective treatment of underlying causative conditions can arrest or reverse the process of devascularization and prevent loss of medullary tissue.
Assuntos
Medula Renal/patologia , Necrose Papilar Renal/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriúria/diagnóstico por imagem , Complicações do Diabetes , Seguimentos , Hematúria/diagnóstico por imagem , Humanos , Medula Renal/irrigação sanguínea , Medula Renal/diagnóstico por imagem , Necrose Papilar Renal/etiologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Necrose , Piúria/diagnóstico por imagem , Traço Falciforme/complicações , Infecções Urinárias/complicaçõesRESUMO
OBJECTIVE: To describe the sonographic appearance of ureteric obstruction due to necrosed papillae. METHODS: In this study, carried out over 3 years 6 months, patients with diabetes mellitus who had renal colic were studied by sonography. RESULTS: In 15 patients with hydronephrosis, there was a soft tissue mass of necrosed papillae filling the ureteric lumen at the site of obstruction. Necrosed papillae were seen in medullary cavities of the ipsilateral kidney in 5 patients. Ureteroscopic removal of necrosed papillae was done in 13 patients. One patient was not fit for an invasive procedure. CONCLUSIONS: When patients predisposed to renal papillary necrosis have renal colic, and sonography fails to show a ureteric calculus, it is best to look for necrosed papillae in the ureter, which may be causing obstruction.
Assuntos
Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Necrose Papilar Renal/complicações , Necrose Papilar Renal/diagnóstico por imagem , Obstrução Ureteral/complicações , Obstrução Ureteral/diagnóstico por imagem , Complicações do Diabetes , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Necrose , UltrassonografiaAssuntos
Necrose Papilar Renal/diagnóstico por imagem , Medronato de Tecnécio Tc 99m , Criança , Diagnóstico Diferencial , Feminino , Humanos , Necrose Papilar Renal/diagnóstico , Osteomielite/diagnóstico , Osteomielite/diagnóstico por imagem , Cintilografia , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , UrináliseRESUMO
The patient was a 66-year-old female who had been commonly using an analgesic for rheumatism from age 40. She visited our hospital with the complaints of fever up and right flank pain. Right hydronephrosis and renal failure were pointed out, and she was referred to the urologic clinic. Retrograde pyelography showed a clubbed upper calyx and filling defect in the lower ureter. A ureter stent was positioned for drainage in the right ureter. Then her general state improved. Three weeks later, retrograde pyelography was performed again. Two filling defects were detected in the upper ureter. Since the obstruction persisted we observed the ureter by ureteroscopy. Two specimens black-brown in color and 8 mm in diameter were observed through the ureteroscope and were removed with a basket catheter. Histological examination of the specimens revealed necrotic transepithelial tissues. It was assumed that the tissues were derived from necrotic renal papilla. Four months later, a similar episode was observed in the left upper urinary tract. The same procedures were performed to manage the patient. In this case, drainage using a ureter stent was effective and conservative therapy was possible. This is the first reported case of renal papillary necrosis managed by transurethral procedures in Japan.